Prospective, multicenter, international phase 2 trial evaluating ultrasonic energy for pulmonary artery branch sealing in video-assisted thoracoscopic surgery lobectomy

Liberman, Moïshe; Goudie, Eric; Morse, Christopher R.; Hanna, Waël C.; Evans, Nathaniel R.; Yasufuku, Kazuhiro; Sampalis, John S.; Malthaner, Richard; Dunning, Joel; Lafontaine, Edwin; Ferraro, Pasquale; Wright, Cameron D.; Auchincloss, Hugh; Lanuti, Michael; Martin, Jocelyne; Ott, Harald C.; Gaissert, Henning A.

doi:10.1016/j.jtcvs.2019.09.061

Cited by 18 publications

(17 citation statements)

References 21 publications

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“…The phase II study published in the current issue of the Journal by the VATS PA study working group examining the use of ultrasonic energy to divide small (7 mm or less) pulmonary artery branches during minimally invasive lobectomy or segmentectomy in 7 centers reaffirms the efficacy and safety of this method. 1 This study further demonstrates the usefulness of advanced energy in making lung surgery easier and safer. This technology clearly works when used correctly, as shown by these authors and others.…”

Section: Scott J Swanson MDmentioning

confidence: 54%

Commentary: Power surg(ery)—The new era of staple-less surgery

Swanson

2020

The Journal of Thoracic and Cardiovascular Surgery

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Section: Scott J Swanson MDmentioning

confidence: 54%

Commentary: Power surg(ery)—The new era of staple-less surgery

Swanson

2020

The Journal of Thoracic and Cardiovascular Surgery

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“…These results could be explained by the mechanical principles underlying the two techniques. In contrast to electrocautery sealing by heat coagulation only, the Harmonic ACE Plus® combines heating and instrument blades mechanical pressure, fusing vessels walls and producing a permanent seal for vessels up to 5 mm [ 3 – 8 , 14 , 16 , 18 , 19 ]. This sealing ability should prevent any oozing or lymphatic leak.…”

Section: Discussionmentioning

confidence: 99%

“…Focusing on VATS lung lobectomy and lymphadenectomy, energy tools such as electric hook (monopolar energy), Harmonic ACE Plus® (ultrasound energy), LigaSure™ (bipolar energy), Enseal® (bipolar energy) and Thunderbeat® (ultrasound energy+ bipolar energy) are commonly used during pleural adhesiolysis, hilar dissection, small vessel sealing and lymph node removal [1][2][3][4][5][6][7][8][9][10]. However, to date the available information is insufficient to establish the superiority of any of these devices in enhancing the postoperative course after this type of procedure [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Energy devices safety and impact on video-assisted thoracoscopic lung lobectomy postoperative course: monopolar electrocautery versus ultrasonic dissector

Cattoni

Rotolo

Nardecchia

et al. 2021

J Cardiothorac Surg

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Background This study aims to compare safety and impact of monopolar electrocautery and ultrasonic dissector (Harmonic ACE Plus®) on postoperative short-term outcomes after video-assisted thoracoscopic (VATS) lobectomy and lymphadenectomy for lung cancer. Methods We analyzed the prospectively collected data of 140 consecutive patients [59% male; median age: 71(IQR:62–76) years] undergoing VATS lobectomy and lymphadenectomy in our institution between October 2016 and November 2019. Patients were divided in two groups based on device used: monopolar electric hook in 79 cases (Group A); ultrasonic dissector in 61(Group B). Energy instrument-related intraoperative accidents, hemothorax/chylothorax incidence, total pleural effusion volume at 48 postoperative hours and chest tube duration were compared between groups. Multivariable analysis was performed to test energy device as possible independent risk factor either for increased pleural effusion volume or for prolonged chest tube duration. Results No intraoperative accidents due to energy device occurred. No hemothorax was recorded. Postoperative chylothorax incidence was slightly higher in Group A (2.5% vs 0%; p-value = 0.21). Total pleural effusion volume at 48 h was significantly higher in Group B: 400 (285–500) vs 255 (150–459) ml (p-value = 0.005). Chest tube duration was similar in the two groups: 5 (3–9) vs 5 (3–8) days (p-value = 0.77). At multivariable analysis the energy device used was not associated with increased pleural effusion volume (p-value = 0.43) nor with prolonged chest tube duration (p-value = 0.28). Conclusions Monopolar electrocautery and Harmonic ACE Plus® were safe and had a similar impact on short-term outcomes after VATS lobectomy and lymphadenectomy, suggesting that energy devices choice could be left to surgeon’s preference.

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“…These results could be explained by the mechanical principles underlying the two techniques. In contrast to electrocautery sealing by heat coagulation only, the Harmonic ACE Plus® combines heating and instrument blades mechanical pressure, fusing vessels walls and producing a permanent seal for vessels up to 5 mm [3][4][5][6][7][8]14,16,18,19]. This sealing ability should prevent any oozing or lymphatic leak.…”

Section: Discussionmentioning

confidence: 99%

“…Focusing on VATS lung lobectomy and lymphadenectomy, energy tools such as electric hook (monopolar energy), Harmonic ACE Plus® (ultrasound energy), LigaSure™ (bipolar energy) and Enseal® (bipolar energy), are commonly used during pleural adhesiolysis, hilar dissection, small vessel sealing and lymph node removal [1][2][3][4][5][6][7][8][9][10]. However, to date the available information are insu cient to establish the superiority of any of these devices in enhancing the postoperative course after this type of procedure [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Energy Devices Safety and Impact on Video-assisted Thoracoscopic Lung Lobectomy Postoperative Course: Monopolar Electrocautery Versus Ultrasonic Dissector

Cattoni

Rotolo

Nardecchia

et al. 2020

Preprint

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Background This study aims to compare safety and impact of monopolar electrocautery and ultrasonic dissector (Harmonic ACE Plus®) on postoperative short-term outcomes after video-assisted thoracoscopic (VATS) lobectomy and lymphadenectomy for lung cancer.Methods We retrospectively analyzed prospectively collected data of 140 consecutive patients [59% male; median age: 71(IQR:62-76) years] undergoing VATS lobectomy and lymphadenectomy in our institution between October 2016 and November 2019. Patients were divided in two groups based on device used: monopolar electric hook in 79 cases (Group A); ultrasonic dissector in 61(Group B). Energy instrument-related intraoperative accidents, hemothorax/chylothorax incidence, total pleural effusion volume at 48 postoperative hours and chest tube duration were compared between groups. Multivariable analysis was performed to test energy device as possible independent risk factor for increased pleural effusion volume or for prolonged chest tube duration.Results No intraoperative accidents due to energy device occurred. No hemothorax was recorded. Chylothorax incidence was slightly higher in Group A (2.5% vs 0%; p-value=0.21). Total pleural effusion volume at 48 hours was significantly higher in Group B: 400 (285-500) vs 255 (150-459) ml (p-value=0.005). Chest tube duration was similar in the two groups: 5 (3-9) vs 5 (3-8) days (p-value=0.77). At multivariable analysis the energy device used was not associated with increased pleural effusion volume (p-value=0.43) nor with prolonged chest tube duration (p-value=0.20).Conclusions Monopolar electrocautery and Harmonic ACE Plus® were safe and had a similar impact on short-term outcomes after VATS lobectomy and lymphadenectomy, suggesting that energy devices choice could be left to surgeon’s preference.

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Prospective, multicenter, international phase 2 trial evaluating ultrasonic energy for pulmonary artery branch sealing in video-assisted thoracoscopic surgery lobectomy

Cited by 18 publications

References 21 publications

Commentary: Power surg(ery)—The new era of staple-less surgery

Commentary: Power surg(ery)—The new era of staple-less surgery

Energy devices safety and impact on video-assisted thoracoscopic lung lobectomy postoperative course: monopolar electrocautery versus ultrasonic dissector

Energy Devices Safety and Impact on Video-assisted Thoracoscopic Lung Lobectomy Postoperative Course: Monopolar Electrocautery Versus Ultrasonic Dissector

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